BRCP Code of Ethics and Practice

PRINCIPLES OF PRACTICE FOR THOSE REGISTERED WITH THE BRITISH REGISTER OF COMPLEMENTARY PRACTITIONERS

The unified profession of Complementary Medicine offers treatments bringing into play the vital force and spiritual energy, in addition to other physical, mental and emotional techniques. This can lead to a patient visiting more than one practitioner or receiving more than one discipline in the course of a treatment programme and the following guidelines are written with that in mind.

Patients and their families must feel they can trust practitioners of Complementary Medicine. To maintain that trust practitioners have a duty to respect all human and animal life and place the wellbeing of the patient as their first priority.

This Code provides a framework within which practitioners of Complementary Medicine are expected to work whilst allowing the public to see the criteria used to protect their interests.

The Complementary practitioner must:

Respect the patient's individuality and beliefs
Treat every patient with care and consideration
Explain treatments in a way that a patient can understand and listen to the patient's views
Respect the patient's rights to be involved in their treatment
Respect confidential information
Ensure that the practitioner's own beliefs do not prejudice the needs of the patient
Recognise the limits of their professional competence and refer on when appropriate
Work with colleagues in ways that best serve the patient's interests
Avoid any act or situation that could compromise the dignity or privacy of the patient
Respect a patient's right to request a second opinion
Be trustworthy in contacts with other health professionals
Strive to represent the profession with honesty and integrity
Be prepared to explain the chosen course of treatment to patients and colleagues
Be aware of new developments and skills
Be fully insured to protect both themselves and the patient (see 1.6)
Work within the ethical criteria and ethos of the profession

1. ENTRY TO THE BRITISH REGISTER OF COMPLEMENTARY PRACTITIONERS

1.1. The British Register of Complementary Practitioners is a listing of professional practitioners offering treatment using specific skills. The range and application of these skills varies from complex structural manipulation (Osteopathy) to Eastern/ Chinese Medicine, soft tissue work, mental and emotional treatments, vital energy level assessment and diagnostic techniques of various types.

1.2. The standards, range of competences and appropriate supporting knowledge for each discipline/therapy/technique are stipulated by the Registration Panels of each Division of the British Register.

1.3. Each Division of the British Register is autonomous and able to recommend variations and additions to this Code from time to time.

1.4. If assessment is necessary practitioners will be required to make a diagnosis within the terms of their own discipline, determine a programme of treatment where appropriate and/or refer a patient on to another health professional.

1.5. Practitioner Insurance must include Professional Indemnity, Public Liability and where appropriate Product Liablity. This insurance must be in accordance with the currrent ICM Approved Insurance Scheme.

1.6. Practitioners living and working abroad must have insurance according to the legal requirements of that country.

2. RELATIONS WITH OTHER PRACTITIONERS

2.1. This Code provides the basis for a professional working relationship between healthcare professionals in conformity with the requirements of patient safety and the law.

2.2. All members of the British Register of Complementary Practitioners are required to abide by this Code of Ethics and Practice.

2.3. The Institute for Complementary Medicine has a procedure to consider claimed infringements of this Code.

3. THE PHILOSOPHY OF COMPLEMENTARY MEDICINE

3.1. The aim of the Complementary practitioner is to assist the patient back to full health, strength and wellbeing at physical, mental, emotional and vital energy or spirit areas of consciousness.

3.2. Complementary Medicine seeks to "complement" the needs of the patient at the time of treatment at the levels of consciousness stated in 3.1.

3.3. Practitioners should be aware of the forms of treatments of other complementary disciplines / therapies / techniques to facilitate co-operation between all the professional services that may be involved.

4. DEVELOPMENT OF SKILLS AND LIMITS OF COMPETENCE

4.1. The purpose of the Code of Ethics is to ensure that members of the British Register of Complementary Practitioners maintain the highest level of responsibility in their practice.

4.2. The Code is concerned with the welfare of the patient, as well as the integrity and the relationship of the practitioner with other healthcare professionals.

4.3. Complementary practitioners must always ensure that the patient interests are given overriding priority.

4.4. Complementary practitioners must take all reasonable steps to monitor, develop and advance their professional competence to the highest level and to work within that competence. Professional development may include in-service training, supervision, counselling, research and other consultative support.

4.5. Complementary practitioners must make clear contracts with patients . The contract must clearly state the practitioner's name and disciplines currently registered with the BRCP. It is not possible to guarantee the outcome of any course of treatment, therefore the terms on which it is offered should be clearly stated before the first session of treatment. Subsequent revisions should be agreed in advance of any change in the treatment.

4.6. When Complementary practitioners offer treatment without payment of a fee they work under the same professional obligation to the patient as when a fee is paid.

4.7. Complementary practitioners must take all reasonable steps to ensure patient safety and conform to health regulations as appropriate to the practice.

4.8. Complementary practitioners must record findings and clinical data methodically, without distortion and take account of the patients' right to inspect their case record.

4.9. Complementary practitioners must be supportive of other health professionals and maintain patient confidence at all times, except with the patient's permission to discuss with colleagues when making a formal referral to another qualified health professional.

5. CLINICAL PRACTICE

5.1. The Code of Practice offers general guidance on the presentation of Complementary Medicine and the ways to make or receive referrals from other practitioners or services.

5.2. Complementary practitioners must conduct their practices at the highest professional standard in their personal appearance, hygiene and appropriate decorum.

5.3. The premises must be clean, adequately furnished, heated when appropriate and provide washing facilities. A changing room and/or shower facility should be available where appropriate.

5.4. The consulting room should be fully insulated for sound from the waiting area.

5.5. Patients should be warned when a specific treatment requires the removal of clothing where this is not immediately obvious. Practitioners must appreciate the patient's need for privacy and modesty and allow them to have another person of their choice present if they so wish.

5.6. Case records must be kept secure at all times.

5.7. Complementary practitioners offering products or a dispensing service must ensure that these items are under supervision when not locked away.

5.8. Complementary practitioners on the British Register must not:-

5.8.1. Use the title "doctor" before their name unless they are registered physicians with the Medical Association in the country of practice. Complementary practitioners who are not registered physicians but are entitled to use the term "doctor" may state it after their name with the appropriate qualification i.e. Doctor of Acupuncture, China.

5.8.2. Refer to or address an assistant as "nurse" unless that assistant holds a nursing qualification in the country in which the practice is being operated.

5.8.3. Conduct a genital examination of a patient without a chaperon being present unless written consent has been given.

5.8.4. Conduct a physical examination of a child under age of 16 years of age except in the presence of a parent or guardian or other responsible adult.

5.8.5. Make any claim, either oral or written, for the cure of any given disease.

5.9. Complementary practitioners must be aware of those diseases which are notifiable in their country of practice and take appropriate action to conform with the requirements of the local Health Authorities or laws. See Appendix 1

5.10. When Complementary practitioners refer a patient on, the following considerations apply:

5.10.1. If they consider the case is beyond their technique, capacity or skill, the usual referral procedure appropriate to the discipline will be followed.

5.10.2. If they require advice from a more senior practitioner.

5.10.3. In the latter case full details of the medical history should accompany with the date and details of all treatments given.

6. ADVERTISING AND ANNOUNCEMENTS

6.1. Complementary practitioners may advertise a practice or service, exercising care that nothing is said or implied that would discredit Complementary Medicine.

6.2. The following guidelines must be observed:

6.2.1. Stationery and nameplates should contain the minimal information needed to be descriptive but make no claims as to quality or effectiveness.

6.2.2. Professional announcements in the Media shall contain the minimal information, as on stationery.

6.2.3. Standard classified entry in telephone directories shall contain name, profession, qualifications, practice title, times of surgeries and address.

6.2.4. Practitioners are advised to use their first name or other indication of their sex with the surname/s.

6.2.5. Only professional qualifications from accepted organisations or Degrees conferred by established Universities should be displayed in practices. Qualifications from abroad must be accompanied by the country of origin e.g. James Other, Dr. Acu (Beijing), BRCP (Chinese Medicine).

6.2.6. Practitioners may add the letters BRCP, followed by the title of the Division/s to which they belong, e.g. BRCP (Osteopathy, Nutrition). Practitioners may print the title in full if they wish e.g. British Register of Complementary Practitioners (Homoeopathy).

7. PUBLIC STATEMENTS AND DEMONSTRATIONS

7.1. Practitioners are advised that they must exercise care in making any public statement and should not present any facts or opinions purporting to represent the views of the BRCP without obtaining written consent from the Registrar. The BRCP reserves the right to examine any material before giving such consent.

7.2. Practitioners may be called upon to give a demonstration of their discipline. In these cases, the modesty and dignity of the patient must be preserved and they must not be brought into ridicule. In case of doubt, the matter should be referred to the BRCP.

8. DEATH OR RETIREMENT OF A PRACTITIONER

8.1. Practitioners should make arrangements for the correct disposal of case records in the event of their death. Executors are advised to contact the British Register for advice.

8.2. Practitioners who sell or otherwise transfer their interest in a practice must inform all their patients of the change and give the name of the practitioner to be responsible for their treatment.

8.3. No information on a patient shall be provided to the incoming practitioner without the permission of the patient.

9. MEDICAL DIAGNOSIS

9.1. The Complementary practitioner will use a number of techniques to assess the presenting symptoms of the patient, the underlying causes and the potential treatment/s which may be appropriate.

9.2. Distinction should be made, wherever possible, between potentially life- threatening conditions and chronic states.

9.3. In the case of 9.2. the patient may bring a medical history based on a series of allopathic diagnoses, which will serve to provide an indication of a named condition. However, the Complementary practitioner will need to assess the case from different criteria and no attempt should be made to describe a Complementary diagnosis in allopathic terms unless the practitioner is so qualified.

9.4. Practitioners who wish to refer patients for an allopathic diagnosis or tests should exercise care in the way in which they describe their appreciation of the presenting symptoms, e.g. a Reflexologist is qualified to make a medical diagnosis which might indicate sensitivity in certain areas, but it may be outside their competence to put a allopathic medical name to the condition.

10. WORKING IN HOSPITALS OR GENERAL PRACTICE

10.1. The doctor in charge will usually retain overall charge of the patient's case and will give permission for the treatment to be DELEGATED to the Complementary practitioner.

10.2. Where the practitioner is a nurse, he/ she must act within the current guidelines of the Ethics and Standards Committee of the United Kingdom Central Council of Nursing, Midwifery and Health Visiting. He / she must also act only under the guidance of his / her ward management, observing any code of conduct that may have been devised within the hospital and / or the Area Health Authority.

10.3. Practitioners who are not nurses but who work in hospital wards must, at all times, act discreetly and considerately, taking the greatest care to consult with staff in charge and to avoid any action or behaviour that could obstruct or conflict with the work of other health professionals.

10.4. Information on individual cases may be available to those working in hospitals or private practice, unknown to the patient. Therefore, matters of practice management and cross infection (see Appendix 1) must be read with this in mind.

10.5. The Complementary practitioner must always retain the right to refuse to treat a patient.

11. DISCIPLINE AND COMPLAINTS

11.1. The acceptance of this Code is the outward sign that practitioners wish to establish the relationship between themselves and those to whom they have a professional responsibility. The adoption of such a code is designed to establish the probity and competence of the profession in the eyes of the public and resolve complaints in a transparent manner.

11.2. Practitioners are required to report any complaints or criminal convictions made against them to the BRCP.

11.3. The Disciplinary Committee for the British Register of Complementary Practitioners will be convened to investigate complaints.

11.4. The Disciplinary Committee shall be mindful that it has a duty to sit in a judicial capacity to decide cases in which it is alleged that a practitioner has been guilty of unprofessional conduct.

11.5. The Disciplinary Committee may determine the fitness or competence of the practitioner to continue to practice. The person's name may be removed from the Register if the Committee considers s/he unfit to remain in registration. Such a person may re-apply at a later date for reregistration.

12. INDUSTRIAL DISPUTES

12.1. It would not be proper for a Disciplinary Committee to become involved in the merits of matters connected with industrial disputes. However, the Committee will consider any allegation referred to them, irrespective of whether or not the misconduct has arisen during industrial action or any other circumstance.

Appendix 1

General clinical guidelines with special emphasis on acupuncture and other treatments that involve piercing the skin or taking blood.

INTRODUCTION

Practitioners of Complementary Medicine rely on touch so every care should be taken of the condition of their hands. In the event of any cut or skin conditions, latex gloves should be worn.

Guidelines for clinical practise involve the need to ensure that general cleanliness and practitioner and practice preparation include making washing facilities, clean towels and gowns available for patients (where appropriate).

The policy is designed to ensure that every attempt is made to avoid cross infection and patients should be asked if they have been in contact with or suffer from any notifiable disease.

NOTE: The Department of Health from time to time issues guidance to practitioners. This is circulated when received by the ICM. Practitioners are also advised to check direct with the Department of Health to ensure they have up to date information.

CATEGORIES OF INFECTION AND INFECTING AGENTS

1. Open lesions or wounds

2. Chronic skin conditions

3. Notifiable diseases

4. Hepatitis B and C virus, HIV, MRSA, CJD

USE OF ACUPUNCTURE NEEDLES

Disposable needles must be used.

DISINFECTANTS

An appropriate dilution of disinfectant must be used after any suspected contamination.

PRACTICE PREPARATION

Overall cleanliness of the practice must be maintained on a daily basis.

Ensure that the couch is clean and covered by fresh paper or other for each patient.

Ensure there is an accident book to record any unusual incident.

OPERATOR PREPARATION

Attire should include washable clothing; hair should not come into contact with the patient and jewellery should be removed or covered.

Nails should be clean, short and free from nail varnish.

Any cut or abrasions of the hands should be covered with latex gloves that are discarded after each treatment of a patient. Waterproof dressings must be changed after each individual treatment.

GUIDELINES FOR USE OF MOXIBUSTION

Care should be taken to ensure that the patient is not left alone and measures are used to protect the patient's skin during moxibustion treatment.

GUIDELINES FOR THE USE OF ELECTRICAL STIMULATORS

Practitioners should ensure they are aware of special precautions to be taken and the contra-indications for electrical acupuncture.

LOCAL POLICIES -

These concern:

Accidents on patients with known infections

MRSA, CJD policy
Needle stick injuries

Sharpes and Waste Disposal

The Health Services Advisory Committee of the Health and Safety Commission 1982 has drawn up the following guidelines.

Categories of Waste

Group A. Normal waste produced during teaching or administrative duties, which is commensurate with the normal function of a teaching establishment.
Group B. Clinical waste to include all items destined for incineration, which includes syringes and needles.

Storage, Transportation and Disposal of Waste

The local Department of Environmental Health will advise on specific arrangements on a local basis for all refuse under Group B.

Appendix 2

DISCIPLINARY & COMPLAINTS PROCEDURE

Available as a separate document.

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